CMS Manual System - Louisiana Department of Health and Hospitals

Probes: §483.40(e)
Do the facility‘s attending physicians delegate to NPs, clinical nurse specialists, or PAs?
Do NP/clinical nurse specialist/PA progress notes and orders follow the scope of practice
allowed by State law?
What evidence is there of physician supervision of NPs or PAs? For example, do
physicians countersign NP/PA orders, if required by State law?
§483.40(f) Performance of Physician Tasks in NFs
At the option of State, any required physician task in a NF (including tasks which the
regulations specify must be performed personally by the physician) may also be satisfied
when performed by a nurse practitioner, clinical nurse specialist, or physician assistant
who is not an employee of the facility but who is working in collaboration with a physician.
Interpretive Guidelines §483.40(f)
If delegation of physician tasks is permitted in your State and the physician extender does not
meet the qualifications listed here, cite F388.
Procedures §483.40(f)
If a nurse practitioner, clinical nurse specialist, or physician assistant is performing required
physician tasks in a NF, is this allowed by the State? Is this person an employee of the facility?
(Facility employees are prohibited from serving in this capacity.)
Probes: §483.40(f)
Is this person working in collaboration with the physician?
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F406
(Rev. 66, Issued: 10-01-10; Effective/Implementation Date: 10-01-10)
§483.45(a) Provision of Services
If specialized rehabilitative services such as, but not limited to physical therapy, speechlanguage
pathology, occupational therapy, and mental health rehabilitative services for
mental illness and mental retardation, are required in the resident’s comprehensive plan of
care, the facility must--
(1) Provide the required services; or